Making contraceptive freedom a reality in vulnerable communities

Relationships and sexuality education session, Bucharest

Today is World Contraception Day – a day for raising awareness about contraceptive care. It might seem surprising that we still need to raise awareness - isn’t everyone in Europe using modern contraception nowadays? Unfortunately, the answer is no.

In Romania, Bulgaria and Serbia, for example, less than half of women use a modern method. Many women and girls from the poorest and most socially excluded communities in the Balkans rely on withdrawal. Contraceptive use is hugely influenced by myths and misinformation about hormonal contraception. This can be tackled by raising awareness and providing accurate information, which is exactly what we are doing in Roma communities in these countries. With support from the communities, our local partners are training and building essential life skills among Roma women and men to enable them to act as points of contact for their friends, children, neighbours and family. And this approach is bearing fruit.

Last year, I visited Kosharnik, a neighbourhood in the city of Montana in the north of Bulgaria, where 6000 Roma have settled. 600 of them live in extreme poverty, without running water or electricity. They form a ‘ghetto within the ghetto’. Many have no income and struggle to survive. Contraception is a life-changer for women living in this neighbourhood. One young woman living here told us that local sessions organised by a health mediator from the community had convinced her of the advantages of contraceptive care. She had married at 17 and now, three years and one child later, had decided after careful consideration with her husband what was right for her:

“One day, we spoke again.. about what is a good number of children in a family... I thought more about me and my family. We didn’t have a high income and could barely pay our bills. Our daughter was a baby and it was challenge to look after her. With my husband we started to discuss it, and I started to think about getting an IUD... That’s how six months ago I decided to have one fitted… My friends told me I’m crazy, they said I only have one child. But I know that I can decide myself when to have another, and that I’ll do so consciously.”

Raising awareness is just part of the solution. Roma women and girls face many more hurdles to get the family planning services they need. Many are uninsured, which makes contraceptive care costly, so we support them to get health insurance. Often, it takes hours to reach healthcare services on public transport, so most women can’t even make the trip. That is why our Bulgarian partner collaborates with a doctor who visits the nearby community health center to provide contraceptive care free-of-charge. We encourage and even push doctors to get out of their consultation rooms and provide information, counselling and even services in the communities. This simple intervention boosts access for women and girls, but crucially also opens the eyes of the doctors, helping to change their perceptions and attitudes towards Roma people. In the words of one Serbian doctor: “This field work teaches me that we have to act like a human, to take the time to listen, ask and help”.

Social norms and expectations are another reason that the uptake of contraceptive care is very low. Why would a young girl ask for contraception if she’s not even supposed to have sex before marriage? Or why would a teenage couple use contraception if they just got married and are expected to start a family as soon as possible ? Why would a man propose to his wife to use a condom – is he cheating on her?

Young people and their communities need to talk - not just about contraception, but about sex, sexuality, relationships, gender, consent, and more! That’s why we support teachers, local nurses, health mediators and young people to build these essential life skills in their children and peers. Young people and children love the relationships and sexuality education sessions and even the adults we have trained get excited seeing the children’s enthusiasm. A community nurse in Romania told us: “This has helped us to see that more can be done... You realise that for a young girl of 11 or a young boy of 12, questions like "how to use a condom" or "what happens when you have sex with a girl on her period", are clearly taboo, and they have no one to talk to about these things because in their families it’s seen as shameful.... But we're trying to move forward and explain that it’s not bad to talk about these things..."

Our work in the Balkans with some of Europe’s most vulnerable communities brings home just how much contraceptive care still changes and saves lives in Europe. It also highlights that making contraceptive freedom a reality for everyone requires civil society, decision-makers and care providers to unite as a team, with and for local communities. Above all, political commitment is needed to ensure all women can live safe and dignified reproductive lives.

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Marieka Vandewiele is a Senior Programme Advisor at IPPF EN's Regional Office. 

Photo: Young people take part in a relationships and sexuality education session in a Roma community in Bucharest 

You can read more about this work here.